The status of aid to the medically needy

Medical indigence, as incorporated in Medicaid legislation, is official recognition that medical expenses are frequently large and often unpredictable, and that the consequences of not using needed services because of their cost can be serious. Under the law, states may make eligible for medical vendor payments people whose incomes, while sufficient for the normal expenses of living, are not large enough to cover the costs of medical care. States which choose to do so may enroll people for Medicaid benefits whose incomes are as much as 133 1/3 percent of the eligibility level for cash grants to families of comparable size under the state's program of Aid to Families with Dependent Children (AFDC). Of fifty jurisdictions with Medicaid programs, twenty-one have decided not to include the medically indigent. Of the remaining twenty-nine, ten have set eligibility at levels less than the figure at which an AFDC family would begin to receive cash income maintenance grants, and twenty-two have set them below the maximum permitted by federal law. Similar figures are presented for the aged showing that twenty states have set eligibility levels below that for the Supplemental Security Income program. Thus, the concept of medical indigence has been eroded by eligibility decisions in more than half of the states, although it remains important, especially for the elderly with large expenses for long-term care.